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Exercise for treating people with diseases of their peripheral nerves (peripheral neuropathy)

Peripheral neuropathies are a wide range of diseases (both genetic and acquired) affecting the peripheral nerves. Symptoms can include pain, altered sensation such as tingling or numbness, muscle weakness and fatigue. Exercise therapy, with a view to improving strength and stamina, forms part of many rehabilitation programmes after a peripheral neuropathy. This review found inadequate evidence from randomised controlled trials to evaluate the effect of exercise in disability in peripheral neuropathy. There was evidence that strengthening exercises moderately improve muscle strength in people with a peripheral neuropathy.

Authors' conclusions:

There is inadequate evidence to evaluate the effect of exercise on functional ability in people with peripheral neuropathy. The results suggest that progressive resisted exercise may improve muscle strength in affected muscles.

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Background:

Peripheral neuropathies are a wide range of diseases affecting the peripheral nerves. Demyelination or axonal degeneration gives rise to a variety of symptoms including reduced or altered sensation, pain, muscle weakness and fatigue. Secondary disability arises and this may result in adjustments to psychological and social function. Exercise therapy, with a view to developing strength and stamina, forms part of the treatment for people with peripheral neuropathy, particularly in the later stages of recovery from acute neuropathy and in chronic neuropathies.

Objectives:

The primary objective was to examine the effect of exercise therapy on functional ability in the treatment of people with peripheral neuropathy. In addition, secondary outcomes of muscle strength, endurance, broader measures of health and well being, as well as unfavourable outcomes were examined.

Search strategy:

In September 2009 we updated the searches of the Cochrane Neuromuscular Disease Group register, MEDLINE (from January 1966), EMBASE (from January 1980), CINAHL (from January 1982) and LILACS (from January 1982). Bibliographies of all selected randomised controlled trials were checked and authors contacted to identify additional published or unpublished data.

Selection criteria:

Any randomised or quasi-randomised controlled trial in people with peripheral neuropathy comparing the effect of exercise therapy with no exercise therapy or drugs or an alternative non-drug treatment on functional ability (or disability) for at least eight weeks after randomisation was included.

Only one trial fully met the inclusion criteria. An additional two trials assessed outcomes less than eight weeks after randomisation and were also included. Methodological quality was poor for several criteria in each study. Data used in the three studies could not be pooled due to heterogeneity of diagnostic groups and outcome measures. The results of the included trials failed to show any effect of strengthening and endurance exercise programmes on functional ability in people with peripheral neuropathy. However, there is some evidence that strengthening exercise programmes were moderately effective in increasing the strength of tested muscles.